Jones Peter H
Baylor College of Medicine, Houston, TX 77030, USA.
Postgrad Med. 2003 Apr;113(4 Suppl):5-14. doi: 10.3810/pgm.04.2003.suppl26.135.
The clinical benefit of lowering levels of low-density lipoprotein cholesterol (LDL-C) in primary and secondary prevention of coronary heart disease (CHD) is well established, with the statins recognized as the drugs of choice. Updated guidelines from the National Cholesterol Education Program continue to recognize the importance of aggressive LDL-C lowering in patients with established CHD, as well as identifying CHD risk-equivalent patients who require the same aggressive LDL-C reduction in primary prevention. For such patients, optimal LDL-C levels are <100 mg/dL. The issue of whether LDL-C should be lowered substantially below 100 mg/dL in both types of patients remains unresolved but is being addressed by several ongoing end point trials. With existing statins and others expected soon, LDL-C reductions of more than 60% appear possible. The updated guidelines redefine high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL as a major CHD risk factor in both men and women, and also introduce non-HDL-C as another parameter that predicts CHD risk. Statins effectively reduce the components of non-HDL-C, and some members produce elevations in HDL-C approaching those achieved with fibrates. Accordingly, statin therapy is appropriate for a wide range of dyslipidemic patients.
降低低密度脂蛋白胆固醇（LDL-C）水平在冠心病（CHD）一级和二级预防中的临床益处已得到充分证实，他汀类药物被公认为首选药物。美国国家胆固醇教育计划的更新指南继续认可在已确诊CHD的患者中积极降低LDL-C水平的重要性，同时也确定了在一级预防中需要同样积极降低LDL-C的CHD风险等同患者。对于此类患者，最佳LDL-C水平<100 mg/dL。在这两类患者中，LDL-C是否应大幅降至100 mg/dL以下的问题仍未解决，但正在通过几项正在进行的终点试验来解决。使用现有的他汀类药物以及预计很快会有的其他药物，LDL-C降低幅度超过60%似乎是可能的。更新后的指南将高密度脂蛋白胆固醇（HDL-C）水平<40 mg/dL重新定义为男性和女性的主要CHD风险因素，并且还引入非HDL-C作为预测CHD风险的另一个参数。他汀类药物可有效降低非HDL-C的成分，一些他汀类药物可使HDL-C升高，接近贝特类药物所达到的水平。因此，他汀类药物治疗适用于广泛的血脂异常患者。
